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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transcatheter arterial chemoinfusion and/or chemoembolization of the internal iliac artery have been used for the treatment of pelvic malignancies. Intraarterial chemoinfusion is expected to deliver a higher concentration of chemotherapeutic agents directly to the neoplasm, reducing the problems of systemic side effects. In 35 cases of pelvic malignancies, 61 procedures of intraarterial chemoinfusion and/or chemoembolization of cisplatin (CDDP) and/or adriamycin (ADR) were performed in combination with or without occlusion of the superior and/or inferior gluteal arteries by the use of steel coils. For chemoinfusion and chemoembolization, the anterior division of the internal iliac artery was selected. In 19 procedures of 14 cases, pain of the lower extremities and the hips developed soon after chemoinfusion and chemoembolization, and gradually followed by paresthesia. Each patient was complicated with numbness, dysesthesia and/or weariness of the lower extremities, thighs and the plantar and dorsal of the foot. These symptoms continued long without recovery. Additionally, the most severe complication such as paralysis and muscular atrophy of the unilateral lower limb occurred in one patient, and at the 14 months follow-up the patient was still suffering from paralysis and gait disturbance. A neurologic examination revealed damage of the sciatic nerve at the level of L5, S1 and S2. It was suggested that the cause of the neurologic complications was attributed to ischemia and/or to deliver a higher concentration of chemotherapeutic agents of the sciatic nerves, and that any previous surgery, radiotherapy or intraarterial chemoinfusion combined with embolization was not related to the symptoms under discussion.
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PMID:[Neurologic complications following intraarterial chemoinfusion and/or chemoembolization of pelvic malignancies]. 279 64

Forty-seven consecutive patients presenting acutely with repetitive symptoms indicative of anterior circulation ischemia ("crescendo" transient ischemic attacks) were evaluated to identify clinical features that might reliably predict the presence of significant stenosis, ulceration, or both in the presumably symptomatic internal carotid artery. Angiographic or intraoperative correlation was obtained in all patients, and 26 (55%) were found to have anatomically significant disease. Of 20 patients with signs or symptoms suggestive of cortical ischemia, amaurosis fugax, or both, 17 (85%) had "positive" angiograms; of 18 with numbness/weakness only, 9 (50%) had positive angiograms; of 9 whose symptoms suggested lacunar ischemia, none had positive angiograms.
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PMID:'Crescendo' transient ischemic attacks: clinical and angiographic correlations. 334 Feb 80

Two cases of subclavian steal syndrome are reported. Symptoms included light-headedness or syncope, reflecting vertebrobasilar insufficiency, and in one case, numbness and tingling in the left upper extremity, reflecting ischemia. Many persons with this syndrome are asymptomatic. Key findings include unilaterally decreased pulses and a significant difference in blood pressure between the upper extremities. Arch aortography, the "gold standard" of diagnosis, must be performed before surgical intervention.
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PMID:Subclavian steal syndrome. A report of two cases. 334 Jun 10

The elbow flexion test is a little known, inadequately standardized, and poorly understood clinical test for the cubital tunnel syndrome. To evaluate and define this test, 13 patients with clinical and electrophysiologic evidence of cubital tunnel syndrome were tested with elbow flexion in a standardized manner. This consisted of full elbow flexion with full extension of the wrists for three minutes. All patients noted the onset of or the increase in one or more of the symptoms of pain, numbness, or tingling with this test. Numbness and tingling followed the sensory distribution of the ulnar nerve, but pain was not limited to the ulnar nerve distribution. The symptom complex, rapid onset, and rapid resolution of symptoms support a locally induced segmental ulnar nerve ischemia as the cause of symptoms. This study demonstrates the elbow flexion test to be a useful, reliable, and provocative test for the cubital tunnel syndrome.
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PMID:The elbow flexion test. A clinical test for the cubital tunnel syndrome. 340 26

Eight baseball players developed digital ischemia as a result of repetitive ball impact. Symptoms and signs were coolness, numbness, cyanosis, paleness, and a positive reaction to the digital Allen's test. Seven of the eight players developed digital ischemia between the ages of 16 and 17. Angiograms of four patients with an occluded index digital artery are presented. Thermograms of four patients with a cool area of the left index finger are also presented. We investigated the incidence of digital ischemia by administration of a questionnaire. The respondents were 578 players belonging to clubs in junior high schools, high schools, and colleges. No digital ischemia was found in 207 junior high school baseball players. The incidence increased in high school (66 of 299) and college (29 of 72). The probability of developing digital ischemia corresponded to the accumulated playing time. Digital ischemia occurred characteristically in the left index finger.
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PMID:Digital ischemia in baseball players. 372 87

Spinal cord injury in children often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality (SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8 years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA, 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. Management includes tomography and flexion-extension films to rule out incipient instability, and immobilization with a cervical collar. Delayed dynamic films are essential to exclude late instability, which, if present, should be managed with Halo fixation or surgical fusion. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.
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PMID:Spinal cord injury without radiographic abnormalities in children. 708 88

A 67-year-old woman experienced a severe headache and vomiting. A computed tomographic (CT) scan showed a mild subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm at the apex of the basilar artery. Several days later, she noticed mild hemiparesis of the left extremities. She underwent a clipping operation on the aneurysm by approaching from the right temporal love. Postoperatively, she developed diplopia and dilatation of the left pupil. Cerebral angiography revealed an occlusion of the left posterior cerebral artery. She was admitted to another hospital in order to continue rehabilitation. General physical examination was normal. Neurological examination revealed paralysis of the left medial and left inferior rectus muscles and palsy of the left inferior oblique muscle. The pupil of the left eye was dilated, measuring 5 mm in diameter, and it did not constrict to any stimuli. The left superior rectus and levator palpebrae superioris functioned normally. Visual acuity and visual fields were normal except for the influence of a senile cataract. She had a mild left hemiparesis, slight left ataxia and slurred speech. She had numbness of the left half of the body. A CT scan showed small low density areas in the right thalamus and left cerebellar hemisphere. Her ophthalmologic findings were compatible with the inferior branch palsy of the oculomotor nerve. The ophthalmoplegia of this case seems to be due to partial damage of the oculomotor nerve induced by ischemia of vascular supply. It is supposed to be caused by a vasospasm of the left posterior cerebral artery following a clipping operation of the basilar apex aneurysm.
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PMID:[Inferior branch palsy of the oculomotor nerve following clipping of basilar apex aneurysm]. 831 94

Several aspects of tactile, thermal and pain perception were evaluated in an individual (R.S.) with a hemorrhagic lesion centered in her left lateral thalamus. Over a 4-year period, psychophysical evaluations were undertaken every 6-8 months, and five magnetic resonance (MR) studies were conducted. Early tests (1991-1992) revealed large contralateral deficits in R.S.'s perception of touch, innocuous temperature, and mechanically evoked cutaneous pain--more so for the upper versus the lower extremity. R.S. showed a similar pattern for heat pain sensitivity, but a more modest deficit than for mechanically evoked pain. She showed a deficit for cold pain sensitivity on her foot, but not for her hand. Thresholds for all types of stimuli ipsilateral to the lesion were within a normative range. Late in 1993, R.S. demonstrated improvements in sensory capacity for touch and mechanically evoked pain contralaterally, although deficits were still evident. During the same period, heat pain sensitivity improved contralaterally, and strikingly, a permanent, ipsilateral hypersensitivity to heat pain developed in her hand. Throughout the entire testing period, R.S.'s ratings of perceived unpleasantness matched the patterns of perceived pain intensity. Thus, the discriminative and the affective dimensions of her pain would change in tandem. However, perceptible innocuous thermal stimuli evoked no affective response when applied contralaterally, despite being described as pleasant when presented ipsilaterally. Throughout the testing period, R.S. reported a persistent numbness on her right hemi-body. Only during a 3-month period in 1995 did she experience spontaneous pain, which was referred to her right foot. The only change in psychophysical performance related to her right foot was a transient but intense thermal allodynia several months prior to her spontaneous pain. The MR studies over this 4-year period showed changes in the extent of edema, gliosis and/or ischemia that could be related to perceptual changes. Thus, the conspicuous observations in this thalamic lesion case were: (i) differential effects upon the various pain modalities (mechanical, heat and cold); (ii) development of thermal allodynia without mechanical allodynia, including an ipsilateral effect; (iii) a deficit in positive affective responses to temperature; and (iv) the different time courses for changes in evoked somesthetic capacity versus spontaneous paresthesias and pathological pain.
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PMID:A longitudinal study of somesthetic perceptual disorders in an individual with a unilateral thalamic lesion. 927 83

Sudden occlusion of a peripheral artery by embolization or acute thrombosis results in acute ischemia. This is most commonly associated with sudden onset of severe pain, numbness and pallor. Chronic ischemia from peripheral vascular disease results in intermittent claudication. We present a case of peripheral embolization from a left ventricular aneurysm in a previously asymptomatic male who presented to the emergency department complaining of two weeks of pain in his left great toe. Included in the discussion are important diagnostic tests for peripheral thromboembolism and ventricular aneurysm as well as suggestions for emergency department management.
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PMID:Left ventricular aneurysm and peripheral embolism as cause of atypical foot pain. 943 78

The purpose of this study was to determine the clinical characteristics of chronic renal failure patients who developed hand ischemia in the limb carrying the dialysis angioaccess. A retrospective review of the charts of 352 patients who underwent 409 upper extremity arteriovenous access, and who were subsequently diagnosed as steal syndrome, was performed at the Emory University Hospital between February 1992 and January 1997. Hand ischemia occurred after 13 of 299 arteriovenous grafts (4.3%) and after 2 of 110 direct forearm arteriovenous fistulas (1.8%). Six patients developed ischemic manifestations immediately postoperatively, 2 in the first week, 4 after 1 month, and 1 after 1 year. Thirteen occurred in association with the primary access procedure. Two cases occurred following graft thrombectomy and outflow dilatation. Seven patients were mildly symptomatic with dialysis-induced pain, coldness, or numbness; 8 patients developed severe ischemic manifestations in the form of sensory loss in 3, severe intolerable pain with impalpable pulse in 3, and digital gangrene and amputation in 2, one of whom developed an unhealed amputation stump and required a higher amputation level with satisfactory healing of the revised stump. Three patients were treated conservatively, 6 by banding, 4 by ligation, 1 by embolization, and 1 by distal ligation and bypass operation. Clinical characteristics of patients with hand ischemia included long-standing insulin-dependent diabetes (10), chronic hypertension (12), peripheral arterial disease (14; 93.3%), coronary artery disease (8), and systemic lupus erythematosis (1). Severe peripheral arterial diseases are commonly found and may be markers for risk of hand ischemia after access surgery.
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PMID:Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. 953 65


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